Season 3 of the STL Active Podcast opens with an interview with Dr. Glennon Fox.
Dr. Glennon Fox, MD is a Family Medicine Specialist in Saint Louis, MO, and has over 36 years of experience in the medical field. Motivated by his parent's childhood medical experiences, Dr. Fox grew up holding physicians in high esteem. As a primary care physician, Dr. Fox is a "common problem expert." He also serves as a pathfinder through the medical system and as a lifestyle coach for dealing with chronic conditions. In his relationship with patients, he considers the health of the whole person, body, mind, and spirit. His patient-supported practice offers a novel approach to primary care, which strengthens this physician-patient relationship. Dr. Fox focuses so much on his patients' well-being, he even replaced the waiting room with a kitchen so patients feel more at home.
Phone #: (314) 414-2273
This episode has been transcribed by otter.ai
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Hey everyone is Dr. Greg owner and physical therapist at Judice sports and Rehab. On this episode of the show, I'm interviewing Dr. Glennon Fox from Family Doctors Care. Motivated by his parents childhood medical experiences. He grew up holding physicians in high esteem. We discuss his practice and methods for providing quality care for his clients. Dr. Fox focuses on building relationships with his clients to fully help them with their body, mind and spirit.
Without further ado, let's get into the interview with Dr. Glennon Fox. All right, welcome to STL Active today we have Dr. Glenn Fox from family doctors care. Welcome to the show.
Thank you. Thank you appreciate you're very happy for you to be here.
This is a we met about a month ago. So I'm glad to have you on the show today.
I'm glad to be here.
Perfect. So why don't you introduce yourself to the audience? Just tell us a little bit about you?
Well, um, I guess the first thing I would say is I'm husband and father, also a physician in my family physician, been practicing in St. Louis since 1987. I'm from St. Louis. So I know the area I know the people I know. The whole I'm a Cardinals fan. And you know, we get involved in the places we live. I did my training here at university Missouri St. Louis, your research at Washington University Medical School at University of Missouri. I spent three years in North Carolina at Duke University for my residency. By the time I was finishing residency, my mom's health was going down. So it was pretty clear I was going to come back here to be in the area to be with my mom before she passed away. So anyway, and it brought me back here. I met my wife in medical school, my wife's a physician, she also trained to do and family medicine. So she practices St. Louis, she has a home based palliative care practice as well. And, and we've got two boys 26 and 23. And they're out and about once a park ranger and the other ones up in the Boundary Waters. So he's a writer and doing construction. So that's a little bit about my background. Sure. I live in Webster groves. Okay, I am I live in a house that was built in 1880s. So Wow, most of my time is spent dealing with that. Yes, most recently it was that we have a mouse problem. And so yeah, I'm a mouse hunter now. Okay,
that's a pretty good resume.
Oh, yeah, it's a good thing to be able to add. I like it. So you mentioned your your mother was was going through some health issues. I think when we had talked before that you'd mentioned that she and your father may have been part of what got you into the medical profession. So
you know, you growing up, I'm one of five, I want of six boys and five brothers and you growing up and and kind of you want to please your parents, whether you whether you face or not. So, you know, my parents, both of them had serious medical illnesses that were, they were they were saved by physicians, or at least through the skill of a physician. They my father's hearing was restored, my mother's life was restored. And so they held physicians in high esteem. So, you know, you you, you want to say I said boy, be nice to and so yeah, it was it was a really problem when I graduated medical school with my, for my parents. Because, you know, we can come from a working class background, you know, blue collar workers and the first person my family go to college and, and things like that. So, so yeah, it was it was good to be that way. So that was it was inspirational for me.
Absolutely. What Why do you think it was that important? I mean, obviously, you held it in such high regard, but I guess why was it important to please your parents in that situation?
I don't know. You know, a lot. Okay. I, I got five brothers. Okay. And we're all you know, black sheep and things like that. Well, I was, I was a middle child, and I could see where my older brother went astray and I can see when my younger brothers are going wild. Because mom's by that time she's tired, you know? And I was Glenda good. Okay, okay. I was a nerd. Okay. I was the one who was a slide ruler and well, calculator now but you know, hanging off your belt, you know, you were the nerd that was a good student and, you know, so I don't know, it was, it's just the pathway I took. I also, you know, I, I'm a, I like, I'm social, but I'm really good one on one. That's my forte, I like relationships, but I like, I'm not the guy who comes into the room, and everybody's like, oh, Glenn, you know, no, I'm, I'm, I'm, I'm the guy who, you know, will sit down in the corner with one person, and really get to know them. And at the party, and I like the stories of the people that I meet and, and some much better one on one. So this, you know, I was drawn to this, you know, services have been a part of my life. So, in this is a service field that we're in, you know, we serve people, you know, doing research, I did that your research, and, yeah, I remember, Gene Johnson, that research I worked under, he said, You know, I create my own problems, and then try to solve them, I can choose my problems and try to solve them. You know, as a physician, I, I don't I'm, the problems come to me, and then I try to solve, I don't choose my problems, it's whoever walks in the door with a problem, then that's what I had to solve. So it's, it's, it's rewarding in that regard.
And I think that's one of my favorite things about the physical therapy as well as you don't you don't get to choose who comes in the door? No. And you mentioned earlier that you love people stories. So kind of go into how do you get to know your clients with and learn their story different than what a typical physician would?
Well, okay. In my current practice, the advantage I have is time. I, it's, it's all about time. And it's about time that you spend with people. So, you know, with more time you get to you get to know, a whole lot more about them. You know, I mean, I saw patients this morning, and, you know, I say, well, Hoss, I know, you know, your daughter's working on that, that fantasy novel, she's a writer. And so how that turned out is, you know, and we talked about that, and, you know, you know much more about him, because you have the time to sew. And then, you know, with time comes to stories. So, my practice is different. It's been different for less 1617 years, built around a model of them. kind of slow medicine. People would say, you know, we'd like to Dr. Fox, but you know, you're just too busy are always, always always constantly apologizing. Now, this is before, right, right when I was in, so maybe let's let's kind of talk about what was your previous practice? This is working for you.
I was an employed physician through one of the hospital systems.
Okay, and what would a typical day or typical week or typical patient visit look like in that previous setting?
Well, I mean, you know, again, I've been away from it for 17 years, I don't know if it's changed or not. But back then, you, you had three rooms that that you patients were roomed in, and you started the day, whatever time you're starting. And usually, by the time when you walked in, there was three people in there were three people there already. I mean, you know, so you're already behind. So you spend 1015 minutes, you know, basically, it got to the point where the goal of my goal of each encounter was, how do I get out of this room? What can I do to get out of the room, because I know two other people are waiting. And that's just people that are roomed not two people that are in the big waiting room that are brought back as soon as the room opens up. So you know, it was just kind of like rock and roll. Let's go, let's go, let's go. And so I'd say, you know, I made a lot of door handle diagnoses. And you know, and then you know, the worst thing is, you know, people come in with you know, my my hangnail, but what about that chest pain, you know, but they tell you about chest pain as you're leaving, right? Or the woman who's got a life falling apart. And then she starts to tear start flowing. And then see write the prescription for Prozac. You throw it at him and you say, Come see me in two weeks. knowing very well that your book, solid for the next two months, much less two weeks. So it was really it was really a I didn't have enough time. I was constantly behind schedule. I was constantly people were constantly on angry with me because of my tardiness. So I decided that if I can get more time, spend more time with people, I give them what they want. So,
so it sounds like, there were, you know, everybody was unhappy, the patients were unhappy that they weren't getting the time with you, you were unhappy, you weren't getting the time with them. And then your employer was probably frustrated that you were always behind. Oh,
my gosh, my employer, I was the slowest family doc there. I mean, I only had a patient panel of really, realistically 2800 patients, and everyone else has got 30 504,000 I mean, one guy, 6000 patients in this panel. And, you know, it's like, they were like, boom, boom, boom, you know? And I would actually, you know, they, this these, the administration, they would do Time Management Studies, they have somebody watch me. And they say, Well, you know, I can see where the problem is here, you're sitting down. So, don't sit down. Don't, don't ever put your don't ever put the patient between you and the door. Don't ever take a phone call. You know, all these things are time wasters. And so that's when I was told that you don't go to the hospital, see patients in hospital, because, you know, you're spending 15% of your time for 10 for 5% of your income. So it's it's a waste of time, you know, let the specialist take care of him in the hospital and to see you spend more time in the office, which is what I did. And I saw people coming back from the hospital saying, Man, I was sick, where were you? I really wanted you to be here. I was so scared. But you know, it just, it was just, I put the marbles in my mouth say, Well, you know, not awful rude. Second, and, you know, and so especially take care of, you know, very poor communication between hospitalist and primary care physicians, sure, even to this day.
So you were just trying to get through that conversation to move on because you didn't really have the freedom to
not so much to do what you wanted to do. You know, I maybe I'm making it worse than it was.
I bet you're not?
Well, I don't know, then. And I left before the electronic health record came in. And that is really, you saw the numbers of so that it's really slowed down. The numbers of the physicians can see not because they're spending more time with the patients. But because they're spending more time with the electronic health record. And that's been it, I think it's a blessing and a curse. But it's been tough. Yeah, I
mean, I use an electronic health record. It definitely takes more time. But I I believe it's more secure and more thorough. But I wish I didn't have to use it right. Same time, right. I'm just that trying to read an electronic health record note is like, it's it's kind of a bunch of BS,
right? There's a lot of stuff that doesn't need to be there. Exactly. You got to check a bunch of boxes just to get through it. And so make sense. So we've kind of talked about the negatives of the previous job.
Yeah, yeah. So you created a new job, a new business. Tell us about your business.
Well, didn't know anything about it. I we actually, it was a an idea that came up I think, in the late 1990s. And it's a West Coast idea. The idea is basically how the practice is financed, and what it allows what it loves physicians and patients to do, but it goes by the name of concierge care. I know where that name came from. I don't like the name because it doesn't really say what I do. There were four docks in Seattle in the late 1990s 1998. And that to that split off, first they went the high road and they created empty square. And they have 50 patients in their panel of patients $20,000 a year each the but they were you know, Bill Gates is Qadri and CL supersonic people and, and, and, you know, they would, you know, 50 patients 20,000 year, that's a million dollars, you know, I mean, they would fly down to Palm Springs and play golf with their clients. And, and so you can see where, you know, terrycloth bathrobes, gold-handled, you know, faucets, you know, the words concierge care for that makes sense for that population. Right,
right. Well, we'll Mitch carton and garrison blish started, clo medical associates. They went to low road. And they said, well, we're going to have like 800 patients in our panel. And we're going to charge books which we charge them. Well what's the cost of premium cable in Seattle. That's that's what will charge per month. And that's how they set their rates. And so I went to Seattle, I met with Mitch and garrison and I followed their model back I liked it because they said, as opposed to other consignors, organizations or companies that put people into business, they said, We don't believe in the idea of, of charging the patient, a yearly or monthly retainer fee, and then charging the insurance company every time you see them. We think that's unethical. And at the time we started, that we thought would be illegal to Well, I guess it's not legal, I don't know, I've never done that. I just basically say, this is this is what I call a patient supporter practice, I get nothing, no income from anybody else except my patients. So basically, you're getting what you're paying for, not what somebody else wants to pay for, or doesn't want to pay for, and will block you, you know, so. So, you know, since January of 2004, I have had zero income from any insurance company, including Medicare,
feels pretty good, didn't it?
Well, you know, at least my incomes not affected by it, you know, I still have the interference of interference, I still have the assistance of, of insurance companies telling me what drugs I can use and what drugs I can't use and whether or not they're gonna let me order a CT scan or whatever. I still have. And you know, look, I mean, everybody needs insurance. I don't encourage people to go without insurance. But you want to insure yourself against the things you don't want. And you want to pay for the things you do want. So if if my kid hits the baseball breaks the window, I don't call my insurance agent and say, fix my window, I fix my window, because I want my window fixed. But if my house catches fire, I just call my insurance company because I don't want a house fire. So the same thing with medicine, look, you should insure yourself against stays in intensive care units or surgeries or, you know, high dollar things. But goodness gracious, if you're just got a sore throat, you want your sore throat better you pay for it. So this first dollar coverage that we sometimes see that, you know, it's there's so much micromanagement of the insurance companies for this first dollar coverage stuff. It's just goofy. So anyway, yeah, I'm with you on that, because I think it's an abuse of the system to have the the $4 prescriptions from Walmart. On January the first you know, it's like, if it's $4, just let me pay $4 in cash rather than, Oh, don't get my insurance card. But I mean, it that is so I kind of do want to get you started. Just to see where this conversation goes. Because if you're frustrated, that's that's good talk radio here. So no, no, you don't Yeah, I don't want to be some, you know, whatever, crazy person? No, I mean, it's, you know, there's two things that that ultimately motivate people and one is what is fear and the others love? What is anger and fear and love, and connection. And so, I'd rather just, you know, I mean, true, I was really angry, when I started my practice, and it really was probably not a good thing to, to motivate me to start this practice. But I've come to love what I do, and the people that I care for. And that's my motivation now. You know, I haven't thought about my old place in years now. There are good people that work there. I mean, I clearly love the guy that used to work with and I still keep in touch with them. Anyway, so where I was going with that other than I don't want to get too mad about talking about it, because I mean, you know, you know, look, insurance companies are the 900 pound gorilla in the room. They they're always there. They're always fair. Yeah. But if my income is not dependent upon what they will or won't pay for, or you know, what, what you have to submit to them under what codes and and you know, have this huge overhead of coders and billers and, and you know, to, you know, you know if that's not there, then at least I can be one with my patient. Honestly, I think I look at what I do is it my office is is a temple. And when you know when we gather there what happens between us is is is good and true and holy. wholesome And I don't want money changes in my temple. I don't want them to be constantly monitoring what I do, and I don't want to have to serve the money changers to give them money changes what they need in order to determine if they're gonna pay me or not. So I, I put the codes down. I spent too much time doing that, but my records, you know, most I just just dictate in what the patient has not a Jr. 2.5 right now, I don't know what, that's fine. How to code and that's okay. You know, I don't know. So it's more about the time you spend with your patients not about what they pay you because they're gonna pay the same whether they see you twice a year or twice a month.
Exactly. Exactly. And, you know, you know, I'll see him twice a month, I'll see him once a week, I got this lady I talked to so I see her now, once a week, I see a lot of patients just once a month, it's Come on, and we'll talk about things and then some people don't, I don't see people for a whole year, you know, it's like, oh, didn't you see it? I feel fine. So, you know, I feel bad about that. I still Oh my god. But you know, the thing is, I'm there, I'm there. And they've always got access to you whether they need it or not, man, it's it's communications in any relationship. Communication is like the most important thing. So you call the office you're gonna get not, you know, you're not gonna have to push buttons to get anything, you're gonna get somebody answering the phone. And then, you know, if I'm with a patient, they'll take a message. We've got a, you can text, we got a texting thing now for the office, he texts the in the Secretary will read the text and say, Okay, do this. And are you and you know, you know, we email all the time you have email stuffing, people text with pictures of rashes, as long as they're not in places when inserting pictures of and we do a lot of stuff going on. And then of course, after hours, you just go to my cell phone, some vailable. Yeah.
And that availability and the access as part of what they're paying for?
I will I think so. Yeah. Even if they don't partake of it or use it. It's the knowledge is there. You don't want to get into this idea that I'm an insurance company, because it's not insurance. Okay. It's, it's just for this kind of, you're paying for the relationship. Sure. Okay. Because I'm not an insurance company, I don't have the insurance company at the late lay back a lot of money in case there's a you know, disaster or something like that. With a patient pays me a year's retainer fee, then that goes into a money market account. And each month, I take out a 12th of that. So if they want to leave, and after three months, well, then we'll give it back. You know, I've not used that. So I don't Sure. Anyway,
but you're not setting aside as, as an insurance company, would you write? Right? Yeah, you have to have, you know, so yeah, and then, of course, be governed by the insurance rules. And just to clarify your statement earlier, here, you're not encouraging people to go without insurance. There, they are going to have the insurance for the catastrophe, the hospitalization, cancer, the broken bone, whatever.
This, um, this, you know, I encourage people to have insurance in the premiums on high deductible insurance are much less than the first dollar coverage insurance. In fact, most companies are going to high deductible anyway. And with that, you know, there's ways of getting things done more cheaply. I've got arrangements with the imaging company and lab that I can get CBC CMP, lipid panel, PSA TSH for 50 bucks. Whereas if you put it through insurance, and it goes against your deductible, that's 350 bucks.
So where does that $300 come from? It's just made up.
Well, it goes to the lab that makes that Yeah, right. Yeah, there's a big lie, right? what's the what's it really worth? If they're okay with accepting 50? Why can't they accept 50? from everyone?
Okay, well, we keep hitting on that. So we'll leave that alone. For now. It it's obvious just in talking to you that you enjoy relationship building with your clients. One of the things that I love and we talked about this right before is the gym that I go to is very community-based and having that community aspect is great. It's kind of hard with medicine, though. I would imagine to an extent. Yeah. Kind of if you would touch on either the relationship building or the community aspect within your practice.
Well, you get to know people you get to know the situations they're in, you know, it's not certainly a requirement, but it's nice to see families. Oh my goodness, you know, I mean, look, if there's something wrong with your liver, it's gonna affect the whole body. If there's something wrong with the Father, it's gonna affect the whole family. And so I like to see families as part of this. So, yeah, you know, the relationships. It just takes time. And when you have more time to sit and talk with people, you know, I feel like I this morning, I had him. I had a, an engineer and engineers always goofy people. They're kind of real egg-headed, like, and, and so he works for the HVC company. And my brother had made some UVC light filtering thing, and I showed it to him, and he was all about it. And they were like, we were talking about that. And, you know, it had nothing to do with why it came in. But it was just a, it created a bond and other bond between him and I trying to think there was something else I want to think about.
But I was I was asking for a specific reason, when I when I walked into your office the first time, I'm not walking into a sterile waiting room. I'm not walking into Oh, yeah, the typical doctor's office?
No, no, Well, look, okay, I can count on probably one, maybe two hands now. And in the 16 years that somebody actually had to wait to see me it was I was busy with somebody else, before I got three rooms full with people in the waiting room. So So if nobody waits to see you, why have a waiting room. So, you know, from a standpoint of it allowed for the redesign of the office. So I thought to myself, well, I'm going to take out the waiting room and, and basically make a kitchen, everybody feel comfortable in the kitchen, you go to somebody's house, there's a party, or they're hanging out in the kitchen, you know, so so I, I built it around a dining room table and a kitchen and we got a refrigerator and and if the patients are want me to I put their pictures of them and their kids and the grandkids and their dogs and their cats and on my refrigerator in my office, that's all those fixtures You see, when you walk in? Those are my people, this is my, you know, you know, it's fine. Like even though even though I'll get lots of calls, in fact, you know, people say, Well, someone so I, you know, Tony says mom said this and this and you know, I made a referral to a podiatrist for somebody I didn't even know because they were a friend of my patients. And I said, Well, here, this is a good podiatrist, you know, so it's kind of like having a doctor in the family. And if you got like a cousin or an uncle or, or you know, you know, somebody that's a physician, you're going to call him up and say, Hey, what do you think about this? Because you know, you're going to get the truth. You know, you're not going to, because, so So yeah, um, you know, you may not have a physician that's related to you. But if you're my patient, you got a doctor in the family. And so you can talk to me about your mom or your distant cousin, or what do you think about this? No, that's a reason to call me.
I love that. That is awesome. And I think it's brilliant. Truly, because when I walked in there, I was like, What is this, but then we just sat around the dining room table, and we had a chat. And it felt like, felt like I was I was very comfortable, because it didn't feel like I'm in a sterile doctor's office with their diploma sitting right in front of me and intimidating. It was very much. I'm just sitting in front of an old friend and having a conversation.
We bake bread on Mondays, and so you come on Mondays, there's bread smell, and we you know, I have fresh, fresh cut flowers every week. And I just want to make it you know, I want this to be a place where people feel comfortable. And so Oh, there you go. Yeah, it just you know, it just makes it he pointed to some flowers he just said it's nice. Anyway, so it's just it's just a nice it's a nice place to come and chat. You know, the the other side is if you make your place look like a home then guess what people just drop by in for the most part. My schedule is such a great Hey, come on, let's talk. In Davis, like I was in the building, I was in the area I dropped by Hi, how you doing? Give them a cup of coffee in there. They're off on their own. So I don't know I like to talk and it's a it's a nice place to to talk.
And it fits your personality because it is that one on one. Yeah, no. And so I mean that. It sounds like that's what you love doing and it fits your personality. I mean, it's it's ideal. For you.
It's, it's been good. It's been good. I, you know, some, you know, some days, not all day, but some days, I love my job. I just love my job I love, you know, you know, because you have the time, oh my gosh, it's amazing how much diseases out there, I said Jesus was all there before I was missing it. You know, it's like because she has a time he's like, Ah, look at this, and I can, I can read about it, I can investigate it. And you know, with the advent of everybody's got every information on the internet night, I've got my own, you know, medical sites today, I subscribe to win King. But it is, I know, it's like, I love being a detective. I love it. It's like, Wow, look at this, you know. And we've uncovered some pretty interesting things in my little practice. That that, um, that just, so it takes, you know, it takes you from being what I was coming to be with, you know, before, when so busy. I was like the traffic cop doc. And it's like, you go here you go here, you go here. And yeah, I can take care of that. But I'm too busy. So you go, you know, to the dermatologist, I said, Well, I can cut that off, you don't have to go to you know, you know, in trying to get it to the dermatologist. Right? So, so it allowed me to practice more of what I was trained to be.
So that's great. And I, you know, personally from my, from my point of view, when I'm working with clients, and we're the same way where it's a full hour each session for each client, before you know someone comes in with knee pain, you're treating the knee because that's what they're there for. Because that's all you have time for, but now actually get to look at the whole body. And we can fix things more efficiently by treating the things that caused the knee to hurt not just treating the, the actual symptom. And it makes a huge difference. And just like you're saying it makes a big difference, being able to go deeper into the questioning deeper into the evaluation to figure out exactly what's going on.
Right. And it's it's so rewarding in especially if you you know, in some respects is kind of like, what was there some goofy medical show house or something like that, you know that that's like, Oh, well, you figured out this this thing was wrong in his house. Like, we're not we're not that smart. But But um,
you don't have a team of writers?
No. Okay. No, I'm not that. Apparently he was like drug addicts or something? I don't know. I never watched it. There. So, yeah, I it is, most days it is just, it's really good. get really good. That's good to hear. You know, and the other thing is, is it because, you know, you know, I'm like a doctor in the family. When you call up after hours. You know, I'm I know, you. You know. You know, and, and, you know, I'm if you have a problem, and I find out about the next next day that you went to the emergency room, you didn't call me it's like why the heck you didn't call me? You know, I'm, I'm a little Yeah, a little concerned that that, you know, I don't want to bother you. Well, what are you paying money for? Right? You know, this is this is I want to be in the loop. Sure. It's hard to be in the loop. When this in this one carousel fragmented. It's hard to be in loop. Right.
So that brings me to the next point, you talk about fragmented care, when I was sending you kind of the form to fill out to see what we wanted to talk about today, you use this quote, that you're a Pathfinder through the medical system and a lifestyle coach for chronic conditions. And I think that really ties into that last point is that in today's healthcare system, everything is so fragmented, but you in your position with being able to spend time with people, you're the doctor in the family, you're able to guide them through that go into that a little bit for me,
well, I wear four hats. The first hat that I'm, I've been trained to be is what I call the common sense. common problem doctor hat. And so if if, if if it's common, if you have a common illness, diarrhea, diabetes, hangnails hypertension, then I'm the expert. That's, that's what I do. I do common problems really well. And it's a common sense approach meaning that if you don't understand what's going on, I'm not doing my job, right. You know, it's it's your body you it's not rocket science, you should know what's going on. Because that's all part of the healing process. Second hat I whereas some Yeah, it's a Pathfinder. medicine can be amazed. And I've been walking the paths of medicine for a number of years now and I can say, Okay, well given this, this and this because you know, 10, sometimes more percent of the time you it's not common, it's it requires a procedure I don't do it's, it's, you know, something that I'm scratching my head about. So I'll get you on the right path, to try to figure out how to fix it or what the problem is. Now, probably the thing I spend most time on with a patient is, is I call a cut on that path, there are cracks. And, and it is amazing how many people fall through the cracks all the time. So I'm a crack filler. I'm a care coordinator, what do you want to call it? You know, I fill in the cracks, I say, okay, you're gonna see Dr. so and so. But before you see diversity, we got to do this, this, this, this and that when you get to sit down. So you're going to be, you know, have everything you need to make that visit better. And I'm going to, I'm going to write after selling so a letter, here's why, here's why I'm sending them to you. It's not they don't have to read it and try to decipher decipher it from some electronic health record, which is in its anyway, so they, if I see a fax fax completed over a letter, with all my supporting information to that doctor, and we usually try to time it like the day before, cuz if we send it any earlier, it's like, Yeah,
yes, I know.
So, so I'm a crack filler. Pathfinder, common problem doctor. And last had is is, you know, basically a coach, and basically, you know, Coach knows how to play the game. Coach can instruct the players on how to approach the second SCOTUS opponent, diabetes, it's a tough opponent, but you know, I've been playing this game with it, I know, I know that what the problems you're going to run into with this, this opponent, but I can't go on the field, technical file, can't be on the field, I can't live your life. So I can say you go home, you do this, this and this. And then when we come back as they want that working for you, you didn't do okay, here, you know, let's regroup. Let's do this. So, you know, I, I don't have you know, I don't have organized, you know, diet programs and exercise programs. And, you know, I'm just kind of just trying to keep it more simple. I seen diets come and go and come and go. And, you know, you know, exercises come and go. So I say things like best exercise equipment is is the person to exercise with find an exercise, buddy, you've got to do that, or you won't do it. enough people are not so disciplined. The best diet? Well, basically, I end up saying that people, I'm gonna tell you the same thing. You heard your mother say, your mother said, eat your fruits and vegetables, get plenty of fresh air exercise to stay away from those kind of girls. And if you did all those things, you'd be fine. You know?
I absolutely. That's awesome. So I think the accountability part is huge there with the exercise buddy statement.
Well, yeah, yeah, but not everybody has that, you know, we're so isolated. We're all in our silos are all on our phones, and we're all doing goofy stuff. And, and, but yeah, personally, I, I've been blessed to have a neighbor that I walked miles several miles with every night, well, four nights a week. And man, if we're not doing that, when I mean, very rarely do we miss because I want to hear what his stories are. What happened today, Dave, you know, and they took a guy. That's cool. He's my buddy.
So out of the four hats that you wear, which, which is the most enjoyable to wear? Oh,
You know, just
I guess there's two different questions there. Yeah. Which is, which is more enjoyable to you? versus, which is more rewarding to you?
Okay, I'm really comfortable with common sense come from, I mean, that that's I, that's what it was trained at. That's what I do. So So you come in with, oh, I can fix it that, you know, that's rewarding. Oh, yeah, we can take care of this, you know, you know, that's no problem. So that's, that's, that's rewarding to for a visit to start and stop in the same time, you know, that to be there. You know, I think probably the care coordination is probably the most important job I do. Insofar as, um, you know, I've had specialists come to me afterwards and say, Oh, my God. Thank you for sending that letter. Yeah, I've been confident of it by my specialty colleagues more often, many times saying like, before we get this person or what why did Dr. Fox send you again? And what pill? Are you on that blue pill, net green pill, the red pill? You know, they're flying by the seat of the pants to figure out because sometimes people don't know. We can't give a history. And so that's probably the most important is to keep people from falling through the cracks. And let me tell you, the cracks are not just in medicine, it's, it's like, well, the insurance company won't pay for that. So I didn't get it. What do you mean? Well, we'll make a doctor, you can advocate advocate on your behalf. Which means jumping up and down screaming, but yeah, I mean, you know, you know, there's lots of cracks between that are that are based on the the medicines becoming our large business and people, you know, Oh, I didn't know they would only fill it, they didn't fill it, you know, this. And so a lot of medicines, a lot of people aren't getting treatment, because of the restrictions put up all along the way.
Gotcha, I can certainly understand that being the most important just because it happens all the time. But people don't know what they're missing out on. Right. You know, medical literacy is pretty low across the country. So
Well, yeah, yeah. It's, you know, people go online, and they, you know, Google their, their diseases, it's like, oh, gosh, but I do have fun, you know, once they have a relationship with people, I do have fun. I do like the coaching. I get this guy. It's just, you know, again, we're very small practice, but there was this. So he was in a, it's really, really rewarding to see him changing. When they when people do change their lifestyles. He's a good old boy. And, and so his diabetes is so out of control. And so I, I am, I created I said, Okay, we I got a club, I want you to join, but you can't join because you're not you're not there yet. So what that says, under seven club, once you're like, hemoglobins, below seven, you get to join the club. And, and I had this little pin said less than seven. And I said this is this will be part of your initiation into the club. And if there's no dues, there's no meetings, it's a great club, to be part of the other seven club. And he's just really fun. We, you know, then, of course, he went down below 70 got be a member of the club, and they went bust him out, man, I think your membership way. You know, it is kind of goofy to stuff like that. I, one of my patients tells me that I'm easy to please but hard to satisfy. Okay. And so every movement he makes and losing weight, I'm so happy. And there's another goal. And there's another goal.
You can't I can't satisfy your man to yours. Well, anyway, that fear, yeah,
that you keep moving the goalposts on him, but sometimes that's important.
Well, with him, he's a preacher and I, I say 90 resting in God's arms. That's, that's the big goal here. So I'm gonna keep you happy and healthy until the day you die. That's a pretty, lofty goal. But that's a good goal to have.
All right, I like it. So you mentioned it. So we got to ask it because I had it on the list here. You mentioned the corporatization of, of medicine. So let's kind of briefly touch on that, because neither of us really like talking about it. But well, you know, I don't know, you know, it's it's the corporatization of our of our world. I mean, it's not just medicine, it's education, you talk to any teacher, and they're like, Oh, I gotta teach you these, these outcome studies are these, you know, this would map testing and things like that. And this is, you know, they could get so much more done educationally if they didn't have to, you know, have these, these outcome analyses. Well, in you know, there's same thing there's corporatization of the agribusiness and you know, everything. Well, it's no medicine was a cottage industry, you know, done by, you know, individual hospitals and individual doctors and engineering offices. And now everything's being corporatized and standardized. And, you know, the art of medicine, the getting to know somebody getting to know, okay, that's your, you know, you just don't fit this, this, this decision tree then supposed to go down this flowchart they're not supposed to use but you know, now I have to do that because I'm part of the corporation. And this is a way we all work. So, you know, it lasts for less than flexibility in individual approaches to patients. And then then, of course, you know, you have to justify your salary by showing, you know, I got to, I got to put down my level of service. And then you got to put down. I haven't done this in years. Um, but yeah, codes and your modifiers and modifiers. Yeah. You know, that's all the physicians are having to do this. Because we're the only ones that seem to be able to do that you will, you know, so you're doing a lot of working. You know, the electronic health record. It's just a glorified cash register. Okay. And, and, and, you know, you can, yeah, okay, let's put in like some words about congestive heart failure, but we got to make sure it's congestive heart failure, diastolic versus systolic versus, you know, violent, you know, there's all kinds of different goofy codes. You know, so, so yeah, you know, to win win money. When money get involved, it seems to be the art of medicine. went away, do something. Yeah. Yeah,
I think it just completely rids the system of critical thinking, it seems like that's kind of where you're going. The Art of it is, is the critical thinking in the relationship building. From my perspective. The PT world, is, when you have such a small amount of time with clients, you're treating based on protocol. And I absolutely hate treating on protocol. In fact, I don't do it anymore. Because it should be a guideline, it shouldn't be a protocol, if I'm treating B via protocol, you could train anyone to do that. There's no clinical judgment, there's no reasoning, it's just this is what you do. Right. And that makes sense. If you are running a machine, right? Everybody's different. And it's, it's, it's asinine to me to, to always treat via protocol, but that was what we were asked to do continuously. And so I just, I kind of have gotten away from that. Because everybody's different. Yes, I'm going to protect your arm after a surgery if you had a shoulder surgery, but we're going to do it within a guideline, not in not by a protocol. That's the I just prefer the use of that word. But but the principle is, I'm going to use my judgment based on the healing time the surgery, you know, and what type of procedure they had. But it's, you know, sounds like kind of similar, similar right there.
Right, you know, you know, physicians, you know, look, the bottom line is money, and people want to get paid more than people, you know, so the physicians that I used to work with they, they knew how to work the system much better than I did, because the person, especially in primary care, they'll come in with more than one problem, Can you believe that? And, and so, you know, they'll say, well, I'll just take, here's one problem today, and you make an appointment The next day, or next time, you know, one problem at a time, you can see a lot of patients. But generally, it's primary care, you're seeing multiple problems at a time and in dealing with multiple different issues. That's really hard to do with the electronic health record, because it's set up on a template basis. So coming in with a sinus infection, I got a template for sinus infection, so I can push that button, but then the other the toe fungus, oh, then what about you know, you know, my, this head is a little pain over here. And you know, before you know it, there's four or five or six, you know, templates up, and you're like, oh, gosh, I. So that's why the physicians were staying till you know, 1011 o'clock at night trying to get the trying to do all the paperwork.
That's obviously not good for the physician. And probably not good for the client either.
No, because you're spending the time that you normally would, with the patient on the electronic health record, satisfying that. I'm happy with what I'm doing. I don't say I still make really, my records are very complete, very complete and readable. And I don't say we shouldn't take record keep records. But um, it's just that it's, I don't, I don't need that to get paid. The
EMR has just become a time suck after a while. So I, I get it. Alright, let's change the subject. Something a little bit more fun to talk about.
All right. What do you learn from your clients?
Well, it's like, every time somebody comes in, it's like, oh, yes. And we're when we left off, and you know, so and so. They were having you know, so I, I say, Well, what happened in the last month? Oh my gosh, tell me finish that story for me. How did that work out? You know. So I love the ongoing saga of their lives.
It's like a cliffhanger at the end of every episode.
It can be it can be in some people's lives or show dramatic like, wow, black cloud here, you know. And so, it's a like that. They, oh my gosh. You know, I have some very intelligent patients very learned patience. And they come in with, I mean, I I just remember when in medical school, there's a Dr. Brent Parker, who's an retired cardiologist. He just love to come into the medical school and just sat there and you sat there and like when the insurance SAT or the medical students hadn't, and I would love them because he called me Dr. Fox and I was this some medical student, though, he said, Dr. Fox, he says, and he said, he would give the sage advice. And he'd say, Dr. Fox says, Listen to your patients. If you listen to them, they'll tell you what's wrong. And so I love to, you know, that, you know, diagnosis is easy if you if you can, you know, kind of listen to what they're saying. And then, and then say that again, once you just say, Oh, so so it's helpful in that regard. To have the time to listen. Before a lot of times, I went into a room, the medical system was scribbled on there, you know, you are I upper respiratory infection. So I'm going okay, this guy's got a cold. That's, that's already starting with a cold. And so now on my door to meningococci me as close because I'm not thinking, you know, but then you know, that colds campus, you know, this, you know, so, so you want to go in there with no preconceived discussion about what's going on, listen to the patient. So that's, that's good. I like that. I like that.
Information biases is a big deal with medicine. So yeah, yeah, I guess that's what it's called. Yeah. And that's, I
see that a ton. You know, I'll get a script from a physician and it'll say, you know, rotator cuff impingement. Okay, well, what do you think I'm thinking about when the person comes in? I wonder what its gonna be. And but it's hard. It's Right, exactly. And so it's hard to look past that and just pretend that you never saw it, and really evaluate them, listen to their story, really evaluate them see what's going on. So I can appreciate that. Yeah, yeah. So my teachers teach me in that regard, a teach me about their lives and their, you know, it's part of having a meaningful life. It's one of the, you know, stories are part of a meaningful life. It's one of the pillars of a meaningful life, the other, you know, relationships. It makes my life meaningful. And I've got a bunch of relationships with people. purpose, I've got a purpose in life that makes it meaningful. And what happens in my office, I often experienced transcendence. It's not like I'm in some trance. But it's, it's where you go, Oh, my God, look at the time. Oh, my God, I can't believe we spent the whole hour. You know, you know, because I mean, I'm just so intent on this one. Connection. So So and you're not worried about what's in the other two rooms?
Because there's exactly nobody in two rooms. Yeah, you're right. Right. Yeah, I can just be with the person. So yeah, that's, it's kind of a sense of transcendence when you're when you're in that room with a person and talking.
So that's, that my patients Teach me so much more. Oh, my God. They teach me what courage looks like. People I've been so honored to be with people as they leave this world. Oh my gosh, you know, they teach me what resilience is all about. They teach me all kinds of things, but how they live their lives. And they also teach me we've got, you know, people that are petulant, and I Oh, God. And we, you know, you know, is that every patient's easy to deal with, you know, we we've got patients who I look the staff, staff and I say, you know, there are our God love them patients, because whenever we say their name, Oh, Mr. So and so God love them because
see, see in Louisiana, we They would say, bless their heart.
Oh, but Oh yeah. Bless your heart. Exactly. Yeah. Like, you know, you're so yeah, it's, it's, um, you know, and it's just, you know, if you just accept people, and their foibles and their Well, that's just her, you know, that's just, you know, we had patients, they call it just about every day, you know, and telling me that they had, this is what their bowel movement looked like, Okay. Okay, great. They're lonely, and they want to talk to him. And I thought that would be a reason to call.
Hey, at least you got a call. That's a good thing. So I think that your answer there is very thoughtful. It's not just, you know, I learned I learned random facts from people. It's, you know, you learn how to live, like you said, a meaningful life. I think that's huge. Is was that a conscious effort of yours? Or is it something that over time you kind of realized, wow, I
am? No, it was over time, is over time, because I feel like this early in my profession. Like, I learned about bonsai trees today, which is cool. I didn't I have a client that grows and maintains bonsai trees, that's pretty cool. But to answer to another part of what you said, She's one of the most resilient people I've ever encountered. So, and I'm kind of taking for granted that resilience, and thinking about the stupid bonds. You know, and, and I think that's, that's probably with experience, like, to an extent, I'm not seeing the big picture of like, the meaning of life. No, but I think that's a, I think that's a great thing to, to keep in mind, we you bring meaning to your life every day. I've had a meaningful day, you know, I made this, you know, I loved how when the kids were little, and they come home, and there'll be the big, you know, how is your day Dad? Who did you see? You know, and I would tell stories, you know, on using names, of course, but they would always love to hear the stories. I'm so blessed, I'm so honored to be in this profession. And that these people have their trust, they have the trust of these people, that they can talk to me, I'm just so honored by that.
I think that's great that you actually enjoy what you do. Because I will tell you, I have a lot of colleagues that don't necessarily enjoy the work that they do. Yeah. And I think that's, that's important. You have created your, your, your profession, and you've created a business that works for you, that you actually can enjoy that works for your clients that works for your, your life and your family. And I think that's, you know, a really big deal because that's part of you know, I can't go back to corporate, I hated it. I hated it so much. So, you know, I'm saying that here on the podcast, I I can't go back to corporate I need this to work for me, and it is working. So I you know, I I can certainly appreciate that. And I think it's a very noble thing that you're doing.
Oh, thank you. Thank you. It's, um, you know, I'll do it for as long as I can do it. It's not without its sacrifice. I mean, I I'm totally not my rich. My original retirement plan was to be retired by now. And retire from a thing I love because I hated so much. And, and so now it's like, oh, I'll just keep doing this. You know, this is this is enjoyable. This brings me to my what, what else would I do? So, yeah, I'm happy at this point in time. That's awesome.
All right. We're getting close on time here. Okay. Anything else that you wanted to chat about for the last seven minutes?
Oh, goodness.Well, there was one question you had on the questionnaire about what have you learned in the last year, something like that, and I, I really come to this, this conclusion that discipline equals freedom. And I didn't realize how much that that played a role and just everything in life. You know, if if you are not disciplined in in how you manage your energy, that means how much energy you expend versus the energy you put into your body. If you're not disciplined in that regard, then you will become enslaved to a body that doesn't work, too. But it doesn't move to buy, they can't get off the ground. And once they fall, you will be enslaved. So, so he but of course, our modern society says discipline, Oh, God, you'd be a slave to discipline, you're gonna have to get up every morning and do that, Oh, god, you're, you're trapped, you're, well, if you're not disciplined, the true enslavement will occur. And you won't be able to basically live with yourself. So I've come to realize that and I don't know if that's a good thing to end on, but it's it's what I learned in these last few years. that's a
that's a great point. And I think it comes I'm assuming it's coming from the the jakka willing book. Did you read that one?
No, no. Okay. Well, there's a book called discipline equals freedom. I didn't know that. Well, now we do. You'll have to read it. Okay. I haven't read it yet. Okay, because I wasn't disciplined enough to read it. No, but, but I've heard great things. It's been recommended to me, I have not read it myself. But he's a I want to say he's an ex marine or something. And he's one of those very, very driven people that can get anything done anytime because he lives a life, lifestyle of discipline. And he's not a as you use the word. He's not enslaved to anyone else. Right? Or to anything else. He's, he's in control of his own life. And that's that freedom aspect, right. But he has to work at it every day. Absolutely. As a part of this is, you know, this is not all I'm going to try to get in shape. And then not get in shape. I mean, all these people who knew discipline, when they were training in their athletes, they lose that and they lose that discipline, and then it just all goes to pot. Somebody to keep up every day.
It's a big deal. I like it.
Yeah, yeah. And, you know, discipline in and not just physical and energy. But you know, you know, the, I'll probably end with this, okay, there's a there's the four gardens of your life. And, and, and, you know, I try to figure out because it's a good health is not just being free of disease, it's being in balance. And it's visiting these four gardens every day. And and checking out so once your is your physical garden, it's just what do you eat? How much you exercise? How are you taking your body? Are you getting your, you know, your mammograms or whatever, you know, how are you taking care of your physical body? That's your physical organ, you should do something every day for your physical body. Of course, we of course, you always eat but what are you eating? The second one is probably the next two, that is the most important, it's a relationship garden. I have been privileged to be with people at the end of their lives and see them out of this world. And never really, nobody said that. I wish I would have had a bigger house or made more, you know, it's all about either happiness about the relationships, thank you so much. I love my children, I love it. Or it's regret about about a broken relationship. Relationships are everything, we should visit those gardens all the time. If you don't visit a garden, it gets overgrown, it gets weeds it gets it dies. The third garden is your intellectual garden. We don't stop learning. When we leave school, read good books, learn something new, learn to dance, learn to, you know, I don't know, there's, there's so much in this world to learn. We live in such a beautiful world learn. And, you know, this is strictly from my my perspective and my upbringing. But there's a spiritual garden that I visit every day. And whether it be through meditation or prayer, or, you know, sacraments or whatever. I'm, it's my belief that we have souls, they animate our bodies, and that we, we should, you know, care for them as well, as well as we do anything else. So I guess, yeah, I'll say that. Okay.
I really enjoy that. That was awesome. This was great. I appreciate your time. I appreciate you being here. This is a good conversation. Thank you. I think there's a lot of good information here. Are you still accepting new clients? You know, I am. But what we do is we have an interview first, okay? Because I want to make sure there's no pretense here. You call up and you say I want to be in alive. I don't advertise. It's all by word of mouth. So if you're, if you know somebody who's already into practice, then that will accept For sure, the one thing I don't want to do is I don't want to promise what I can't deliver. So, you know, sometimes I think I got too many patients and sometimes I think I could use a few more and you know, you know it because people leave the practice people leave the area people die. And, and so, it's a cost. Yes, I am sick to the show. The short answer is yes. Okay.
And if someone listening to the show wanted to inquire about well, that would be
that would they would they get in contact and call my office? Okay, and when that number 314-414-2273
One more time.
314-414-2273. All right.
Thank you very much.
Thanks for being here.
You're welcome. This I'm happy to be here.
Absolutely. This has been STL Active.
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